As concerns about physician wellbeing mount worldwide, an
article in the journal of the Canadian Medical Association, CMAJ, is looking at
how the death of patients is contributing to burnout in healthcare
professionals and how aspects of palliative care can be used to help them cope
with these stresses and reduce burnout.
These aspects include not seeing death as failure, working
on interdisciplinary teams, practising compassionate leadership and developing
competencies to address suffering.
“One promising but relatively unexamined factor related to
physician ill-health is the impact of patient death on healthcare professionals,”
the authors wrote.
In one study, both qualitative and quantitative data
corroborated the finding that the emotional impact of numerous patient deaths
influenced burnout in oncologists. In a recent survey of oncologists, high
levels of burnout, coupled with high levels of grief symptoms, were shown to
increase emotional distress, suggesting that dealing with patient death
contributes substantially to distress among certain physician groups. Research
conducted among other practitioners has yielded similar results: paediatric
nurses’ grief over patient death was positively correlated to burnout.
“There is a dearth of research to tell us whether coping
with patient death may influence burnout among physicians in other specialties.
However, evidence suggests that most health care professionals do not receive
training on how to respond to their feelings about patient death and the
emotional challenges of providing end-of-life care,” the authors observed.
well-conducted survey of French palliative care physicians has found a lower
prevalence of burnout in this group than previously noted in other specialties. A
nationally representative survey of Portuguese palliative care and intensive
care professionals found that the latter were more than twice as likely to have
burnout than those in palliative care. One explanation is that palliative care
physicians are trained to cope with the emotional challenges of patient death.
An online survey of Spanish palliative care professionals found that the
ability to cope effectively with patient death was negatively associated with
burnout and positively associated with quality of life.
“To be sure, palliative care is a unique specialty and there
are a number of factors that may contribute to differences in burnout rates,
including patient volume and administrative burden. Moreover, the death of a patient
in palliative care is anticipated. The death of patients who were expected to
recover may be more challenging. Nonetheless, there may be lessons from
palliative care that could improve health outcomes for other health care
professionals, particularly in the context of patient death,” the authors wrote.
Palliative care physicians may have better health outcomes
for several reasons. Patient death is not viewed as a personal failure, so
palliative care physicians are less likely to have burnout, depression or
stress when patients die. Palliative care physicians tend to work on
cooperative interdisciplinary teams, which has proven to promote better
outcomes for physicians, who may feel less isolated and solely responsible
for making life-and-death decisions about their patients. Furthermore, teams
are nonhierarchical, and all members share an understanding of human suffering
throughout the treatment trajectory, allowing them to process grief and loss in
an open, supportive, compassionate and nonjudgmental way.
Practising compassion is integral to providing palliative
care. Often, unbeknown even to themselves, palliative care physicians use this
skill in taking a compassionate leadership approach to caring for
colleagues. This involves noticing suffering in others, interpreting and
responding empathically to that suffering, taking compassionate action to
alleviate it, and creating a culture of caring and mutual support. Palliative
care physicians are also trained to develop competencies in addressing and
alleviating suffering in all its domains — physical, psychosocial and spiritual
— potentially making them more comfortable dealing with their own suffering.
Physicians are humans caring for other humans. They must acknowledge that they
also suffer and are deserving of the same compassionate, person-centred support
provided to patients.
“More research is needed to evaluate whether all physicians
can effectively incorporate these aspects of the provision of palliative care
into the day-to-day care of patients, to lower the risk of burnout. We believe
that the ethos of palliative care teams has the potential to improve the
well-being of physicians, and in the process, potentially reduce burnout in the
wider medical profession,” the authors concluded.